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Maternal & Child Health Epidemiology: An Overview of Selected Data Systems. Data Users Conference November 17, 2004 Presented by Susan Nalder, EdD, MPH, CNM MCH Epidemiology Program Manager New Mexico Department of Health. MCH Epidemiology, Population Based.

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slide1

Maternal & Child Health Epidemiology:

An Overview of Selected Data Systems

Data Users Conference

November 17, 2004

Presented by Susan Nalder, EdD, MPH, CNM

MCH Epidemiology Program Manager

New Mexico Department of Health

mch epidemiology population based
MCH Epidemiology, Population Based

Uses data variety of data and data sources covering population characteristics, health status by natality, mortality, morbidity and injury, healthy & health risk behaviors, access to and use of primary preventive care

Hand-out shows kinds of data used to monitor this population

Presentation will focus on PRAMS

Special mention of selected projects

mch epidemiology population based3
MCH Epidemiology, Population Based

National Survey of Children with Special Health Care Needs:

Federal MCH-B and NCHS

New Mexico sample 751

Data collected in 2001; reported in 2002

Used SLAITS methodology – need to use STATA or combination of SAS+SUDAAN

Data files and data reports may be accessed: www.cdc.gov/slaits

Data report: www.cdc.gov/nchs/slaits.htm

mch epidemiology population based4
MCH Epidemiology, Population Based

National Survey of Child Health:

Federal MCH-B and NCHS

New Mexico sample ~2,000

Data collected in 2004

Data files available early 2004

Used SLAITS methodology – need to use STATA or combination of SAS+SUDAAN

Data files and data reports will be posted: www.cdc.gov/slaits

mch epidemiology population based5
MCH Epidemiology, Population Based

NM Child Fatality Review and NM Maternal Mortality Review

Data bases developed and in testing 2004; reviews ongoing since 1996

Reports are at www.doh.state.nm.us

Program contact:

Anne Worthington, MPH

Anne.Worthington@doh.state.nm.us

tel 505-476-8888

mch epidemiology population based6
MCH Epidemiology, Population Based

Comprehensive MCH data and information available through the Title V MCH Block Grant program

Over 60 indicators of health status and access to/use of care

www.mchb.hrsa.gov

Online data; can see NM data and any other state

slide7

From Data to Action

NM Pregnancy Risk Assessment Monitoring System

acknowledgements
Acknowledgements

The NM PRAMS team

  • Ssu Weng, MD, MPH, PRAMS Epidemiologist
  • Dorin Sisneros, PRAMS Operations Manager
  • Eirian Coronado, MA, PRAMS Coordination and Epidemiology

The PRAMS Sample Source

- The team in the NM Office of Vital Records and Health Statistics

The Telephone Follow-up

- The team in the Survey Unit, Division of Epidemiology & Response

The CDC PRAMS Team

- Nedra Whitehead, PhD, NM PRAMS Advisor

funding support and ta
Funding Support and TA

The Title V Maternal & Child Health Block Grant (1995 to present)

The PRAMS Project in the Program Services Branch, Division of Reproductive Health, Centers for Disease Control & Prevention in Atlanta (1996-present)

The Medicaid Program, NM Human Services Department (1998 to present)

The Family Preservation & Support Project, Prevention & Intervention, NM Children, Families and Youth Department (1995-1999)

the purpose of nm p r a m s
The Purpose of NM PRAMS
  • To improve the health of New Mexico’s mothers, infants and families
the purpose of nm p r a m s12
The Purpose of NM PRAMS
  • To reduce significant disparities in maternal, infant and family health measures:
    • Disparities: geographic areas, age, race or ethnicity, education, poverty, families with Medicaid paid services
    • Measures: health status, healthy & health risk behaviors, exposure to stressors, access to/use of health & health related services
the purpose of nm p r a m s13
The Purpose of NM PRAMS
  • To produce data and information, and foster its use for
    • Strategic analysis with local groups, translation of data to action
    • Informed Policy
    • Informed decisions about programs, selection of evidence-based services
    • Education of policy makers, providers, present and future mothers & fathers, and the public
    • Monitoring and reporting status and trends over time
about nm p r a m s
About NM PRAMS
  • A multi-year, population-based surveillance system
  • Monitors over 100 selected behaviors and experiences of mothers and infants that occurred before, during or after a pregnancy & live birth … against a background of socio-demographic, economic and cultural characteristics
about nm p r a m s15
About NM PRAMS
  • Preconceptional Period ~ up to 12 months before pregnancy
    • Health insurance before pregnancy
    • Use of multivitamins
    • Height & Weight, BMI calculations
    • Intention of pregnancy
    • Tobacco, Alcohol, Physical Abuse
    • Knowledge about Emergency Contraceptive Pill
about nm p r a m s16
About NM PRAMS
  • Pregnancy
    • When knew she was pregnant
    • Prenatal care, including barriers
    • Payor of care
    • Health education received (11 topics)
    • HIV testing
    • Oral health services
    • Services including WIC and 11 supportive services
    • Prenatal health problems (diabetes, pregnancy related, injuries)
about nm p r a m s17
About NM PRAMS
  • Pregnancy & Delivery
    • Experience of feeling treated unfairly when getting health care
    • Prenatal hospitalizations
    • Tobacco, alcohol, physical abuse
    • Life stressors (13 topics)
    • Payor of care for delivery
    • Length of stay after delivery
about nm p r a m s18
About NM PRAMS
  • Post-Partum to ~2 months
    • Post partum check up
    • Use of family planning method(s)
    • Barriers to using family planning
    • Supportive services (11 kinds)
    • Working or in school, or at home
    • Depression
    • Food security for the family
    • Household utilities
about nm p r a m s19
About NM PRAMS
  • Early Infancy to ~2 months
    • Hospitalization or NICU after delivery
    • Infant feeding
      • Several questions about breastfeeding
    • Second hand smoke exposure
    • Infant sleep position
    • Well child care
    • Infant car seat
    • Home visiting services
    • Family support for infant’s care
more about nm p r a m s
More About NM PRAMS
  • The Sample: random selection from NM live birth registration files

IN: NM Residents, live birth in NM, singleton-triplet

Excluded: Non-resident, Resident but out of state birth, adoption

  • Timing: 2-6 months post-partum
  • Method: mailed survey with telephone follow-up
data collection
Data collection

Up to 3 mailings

Telephone interview for non-responders

Recall bias minimized

  • Mailed 2-6 months after delivery
more about nm p r a m s 1997 2000
More About NM PRAMS, 1997-2000
  • 1997-2000 Sample Design: stratified sample, oversampled low birth weight & Native Americans
  • Statewide, 8,182 sampled; 5,711 responded, 70% response rate
  • 2001-Present, the Sample Design: stratified sample, oversampled by Health District
p r a m s reports mother s residence by public health districts
PRAMS Reports Mother’s Residence by Public Health Districts
  • District I Urban: Bernalillo, Torrance, Valencia, and zip codes for Bernalillo town & Rio Rancho
  • District I Rural: Sandoval (excludes Bernalillo town & Rio Rancho zip), McKinley, San Juan, Cibola
  • District II: Colfax, Harding, Los Alamos, Mora, Rio Arriba, San Miguel, Santa Fe, Taos, Union
  • District III: Catron, Dona Ana, Grant, Hidalgo, Luna, Otero, Sierra, Socorro
  • District IV: Chaves, Curry, DeBaca, Eddy, Guadalupe, Lea, Lincoln, Quay, Roosevelt
more on the p r a m s
More on the PRAMS
  • Statewide Estimates and Other Analysis:

Selected characteristics of the mothers are associated with outcomes, behaviors or other findings.

• Age Groups

  • Race and Ethnicity
  • Education Levels
  • Marital Status
  • Any Previous Live Birth
  • Residence by Public Health District
  • Public Assistance
  • Payor of Care and I.H.S.
    • PNC & Delivery, Delivery Only
point estimate analysis weights
Point estimateAnalysis weights
  • Each respondent “speaks”

for about 12 other women

Not selected for sample or who

did not respond

  • Weighting process complex
      • Done by CDC PRAMS
      • See PRAMS reports on DOH website
potential bias from
Potential bias from
  • Less than 100% response – about 30% do not participate
  • Mail survey: appeals to more educated women, but many less-advantaged women participate
  • Phone respondents vs. mail
  • Recall (2-6 months after birth)
  • Self-report by respondent
nm p r a m s
NM PRAMS
  • Annual Surveillance Report
    • Detailed reporting >20 topics
    • Multi-year reporting >20 topics
  • Special Reports
    • Teen report
    • Medicaid report
    • Topics of interest
nm p r a m s28
NM PRAMS
  • Use of PRAMS by outside researchers
    • CDC PRAMS working on a public use data set …
    • NM PRAMS, qualified researchers may propose an analysis project and obtain data, a process is in place
slide29

Contact information for NM PRAMS

email us at nmprams@doh.state.nm.us

Erian Coronado, MA, PRAMS Coordinator

Tel: 505-475-8895

Ssu Weng, MD, MPH, PRAMS Epidemiologist

Tel: 505-476-8892

Susan Nalder, EdD, MPH PRAMS Director

Tel: 505-476-8890

Maternal and Child Health Epidemiology Program

Family Health Bureau

NM Department of Health

2040 South Pacheco St, Santa Fe, NM 87505